Discharge instructions are well known to be critical for provider-patient communication and have been shown to impact readmission, post-hospitalization follow-ups, and post-hospitalization medical harms. We aim to examine both the use and content of the EPIC provider-directed discharge instruction input boxes entered by hospital medicine providers at UCM to identify areas where our discharge instructions can be improved in the future.

We will specifically look at the areas for providers to select a recommended diet, activity level, call MD symptoms, additional medication details, and a free-text box for additional instructions beyond those inputs. These items are typically supplied along with the updated medication lists and upcoming appointments provided in the EPIC-generated after visit summary. All providers likely use these inputs to some degree, although the use patterns have not been characterized before at UCM. We hope to gather a sample of discharge instructions (about 5-10 discharges) from each Hospital Medicine Provider. We will then examine both the type of information inputs that each provider uses and quantify the most used fields (ie individual questions vs free text) across the group. We will also categorize the content of the free text fields to examine for particular areas including but not limited to diagnosis information, additional medication instructions, and follow-up details. Lastly we hope to develop a template or other recommendations on how to improve the discharge instructions of the hospital medicine section.

1. Examine the distribution and use of various discharge instructions input options provided within EPIC among UCM hospital medicine providers

2. Explore the content of the discharge instructions across our hospital medicine providers to compare to what research has already found to be important

3. Develop a template for hospital medicine discharge instructions or make specific recommendations for what specific steps we may need to take to fill in the gaps in our EPIC-created discharge instructions

SA 1: We have worked with UCM IT to form Slicer Dicer Queries to collect most of the MD input patient discharge instructions. However there are some of the patient discharge instructions that are not easily captured (free text boxes) and therefore will have to be chart reviewed. We plan to collect about 5-10 per each hospital medicine provider and assess how many hospital providers are a) using the discharge instructions, b) which input's are they using and c) how often are they using them

SA 2: We will work to categorize the content of the discharge fields and examine what is most typically included in the discharge instructions. We will also refer to research that has been done in this area to define what has been shown to be useful/important and determine where the UCM providers may be falling short or incomplete.

SA 3: Will start to develop a template (dot phrase with specific instructions) and/or make recommendations for specific steps (different EPIC inputs) that we may need to take to create comprehensive discharge instructions for the hospital medicine section

Will need to have access to EPIC Slicer Dicer for data collection. If qualitative analysis software will be needed, will be determined at a later time and provided.